Provider Demographics
NPI:1760606602
Name:HELAR CAMPOS MD & ASSOCIATES FAMILY MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:HELAR CAMPOS MD & ASSOCIATES FAMILY MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HELAR
Authorized Official - Middle Name:EDGAR
Authorized Official - Last Name:CAMPOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-444-7400
Mailing Address - Street 1:PO BOX 1466
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53008-1466
Mailing Address - Country:US
Mailing Address - Phone:262-788-9229
Mailing Address - Fax:262-788-9241
Practice Address - Street 1:435 MONTAUK AVE
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4621
Practice Address - Country:US
Practice Address - Phone:860-444-7400
Practice Address - Fax:860-444-7401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008026296OtherMEDICARE APRN PIN
CT007228864Medicaid
CT008026296OtherMEDICAID APRN
CT010040341CT02OtherANTHEM
CT008026296OtherMEDICAID APRN